Havasu Medical Supply Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

332B00000X Issued in AZ

Legal business name

HAVASU MEDICAL SUPPLY INC.

Practice address

1849 Acoma Blvd W Ste 116
Lake Havasu City, AZ 86403-3184

Phone

(928) 854-1868

Fax

(928) 854-1865

NPI assigned

Apr 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jim Jay Goldman, CRT

Title

Owner RT

Phone

(928) 854-1868

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1205891124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1849 ACOMA BLVD W STE 116",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864033184",
            "telephone_number": "928-854-1868",
            "fax_number": "928-854-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1849 ACOMA BLVD W STE 116",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864033184",
            "telephone_number": "928-854-1868",
            "fax_number": "928-854-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAVASU MEDICAL SUPPLY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OWNER RT",
        "authorized_official_telephone_number": "928-854-1868",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "332B00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Havasu Foot & Ankle Center
• Havasu Foot & Ankle Center
• Havasu Health Care Pharm
• Havasu Lung and Sleep Disorders Center LLC
• Havasu Medical Care
• Havasu Neurological Center PLLC
• Havasu Nursing Center 2 Inc
• Havasu Physical Therapy
• Havasu Primary Care, LTD.
• Havasu Rainbow Pediatrics

• Durable Medical Equipment & Medical Supplies in Lake Havasu City, AZ
• Providers in Lake Havasu City, AZ by specialty
• Durable Medical Equipment & Medical Supplies in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.